BBA 2011-14

Terminal Disease - Right to Die

BY: Ishani Patel (0220111) SUBMITTED TO: Dr. Kamlesh Misra

18thApril 2013

Contents
Acknowledgement .......................................................................................................................... 2 Introduction ..................................................................................................................................... 3 The Ethics of Euthanasia ................................................................................................................ 4 Why people want Euthanasia? ........................................................................................................ 4 Forms of Euthanasia ....................................................................................................................... 5 Active Euthanasia ........................................................................................................................ 5 Passive Euthanasia ...................................................................................................................... 5 Voluntary Euthanasia .................................................................................................................. 5 Involuntary Euthanasia ............................................................................................................... 6 Indirect Euthanasia...................................................................................................................... 6 Assisted Suicide ........................................................................................................................... 6 Euthanasia Pros and Cons ............................................................................................................... 7 Euthanasia and Technology ............................................................................................................ 8 Religion and Euthanasia .................................................................................................................. 9 Buddhism .................................................................................................................................... 9 Christian ...................................................................................................................................... 9 Hinduism ................................................................................................................................... 10 Islam .......................................................................................................................................... 11 Alternative solution to Euthanasia ............................................................................................... 12 Impact on Society.......................................................................................................................... 14 Cases on Euthanasia...................................................................................................................... 15 Conclusion ..................................................................................................................................... 17 Harvard Referencing ..................................................................................................................... 18

Acknowledgement
The satisfaction and euphoria that accompany the successful completion of any task would be incomplete without the mention of the people who made it possible, whose constant guidance and encouragement crowned my efforts with success. I would like to express a great appreciation to my Vice Chancellor and Mentor Dr. Kamlesh Misra for his constant guidance and support. I take this opportunity to express my profound gratitude and deep regards for the valuable and constructive suggestions during the planning and development of this project. I would also like to express my deep gratitude for the patient guidance, enthusiastic encouragement and useful critiques of this project. The willingness to give his time so generously has been very much appreciated.

Introduction
Euthanasia is a broad term for mercy killingtaking the life of a hopelessly ill or injured individual in order to end his or her suffering. Mercy killing represents a serious ethical dilemma. People do not always die well. Some afflictions cause people to suffer through extreme physical pain in their last days, and euthanasia may seem like a compassionate way of ending this pain. Other patients may request euthanasia to avoid the weakness and loss of mental faculties that some diseases cause, and many feel these wishes should be respected. But euthanasia also seems to contradict one of the most basic principles of morality, which is that killing is wrong. Viewed from a traditional Judeo-Christian point of view, euthanasia is murder and a blatant violation of the biblical commandment Thou shalt not kill. From a secular perspective, one of the principal purposes of law is to uphold the sanctity of human life. Euthanasia is so controversial because it pits the plight of suffering, dying individuals against religious beliefs, legal tradition, and, in the case of physician-assisted death, medical ethics. This moral dilemma is not new. The term euthanasia is derived from ancient Greek, and means good death. But while the debate over mercy killing has ancient origins, many observers believe that it is harder today to achieve a good death than ever before. Advances in medicine have increased peoples health and life span, but they have also greatly affected the dying process. For example, in the early twentieth century the majority of Americans died at home, usually victims of pneumonia or influenza. Today most people die in the hospital, often from degenerative diseases like cancer that may cause a painful, lingering death.

The Ethics of Euthanasia

Euthanasia raises a number of agonizing moral dilemmas:

Is it ever right to end the life of a terminally ill patient who is undergoing severe pain and suffering?

Under what circumstances can euthanasia be justifiable, if at all? Is there a moral difference between killing someone and letting them die? At the heart of these arguments are the different ideas that people have about the meaning and value of human existence. Should human beings have the right to decide on issues of life and death? There are also a number of arguments based on practical issues. Some people think that euthanasia shouldn't be allowed, even if it was morally right, because it could be abused and used as a cover for murder.

Why people want Euthanasia?

Most people think unbearable pain is the main reason people seek euthanasia, but some surveys in the USA and the Netherlands showed that less than a third of requests for euthanasia were because of severe pain. Terminally ill people can have their quality of life severely damaged by physical conditions such as incontinence, nausea and vomiting, breathlessness, paralysis and difficulty in swallowing. Psychological factors that cause people to think of euthanasia include depression, fearing loss of control or dignity, feeling a burden, or dislike of being dependent.

Forms of Euthanasia
Euthanasia comes in several different forms, each of which brings a different set of rights and wrongs. Active Euthanasia In active euthanasia a person directly and deliberately causes the patient's death. In passive euthanasia they don't directly take the patient's life, they just allow them to die. This is a morally unsatisfactory distinction, since even though a person doesn't 'actively kill' the patient, they are aware that the result of their inaction will be the death of the patient. Active euthanasia is when death is brought about by an act - for example when a person is killed by being given an overdose of pain-killers.

Passive Euthanasia
Passive euthanasia is when death is brought about by an omission - i.e. when someone lets the person die. This can be by withdrawing or withholding treatment:

Withdrawing treatment: for example, switching off a machine that is keeping a person alive, so that they die of their disease.

Withholding treatment: for example, not carrying out surgery that will extend life for a short time.

Traditionally, passive euthanasia is thought of as less bad than active euthanasia. But some people think active euthanasia is morally better.

Voluntary Euthanasia
Voluntary euthanasia occurs at the request of the person who dies. Non-voluntary euthanasia occurs when the person is unconscious or otherwise unable (for example, a very young baby or a person of extremely low intelligence) to make a meaningful choice between living and dying, and an appropriate person takes the decision on their behalf.

Non-voluntary euthanasia also includes cases where the person is a child who is mentally and emotionally able to take the decision, but is not regarded in law as old enough to take such a decision, so someone else must take it on their behalf in the eyes of the law.

Involuntary Euthanasia
Involuntary euthanasia occurs when the person who dies chooses life and is killed anyway. This is usually called murder, but it is possible to imagine cases where the killing would count as being for the benefit of the person who dies.

Indirect Euthanasia
This means providing treatment (usually to reduce pain) that has the side effect of speeding the patient's death.Since the primary intention is not to kill, this is seen by some people (but not all) as morally acceptable.A justification along these lines is formally called the doctrine of double effect.

Assisted Suicide
This usually refers to cases where the person who is going to die needs help to kill themselves and asks for it. It may be something as simple as getting drugs for the person and putting those drugs within their reach.

Euthanasia Pros and Cons

Arguments for Euthanasia:

It provides a way to relieve extreme pain It provides a way of relief when a person's quality of life is low Frees up medical funds to help other people It is another case of freedom of choice.

Arguments against Euthanasia:

Euthanasia devalues human life Euthanasia can become a means of health care cost containment Physicians and other medical care people should not be involved in directly causing death There is a Slippery Slope effect has occurred where euthanasia has been first been legalized for only the terminally ill and later laws are changed to allow it for other people or to be done non-voluntarily.

Euthanasia and Technology

Euthanasia has a long history involving vehement debate (Dowbiggin, 2005). Present-day proponents argue, typically, that people have a right to die at a time and place of their own choosing. Instead of spending their final days in a hospital or nursing home with the prospect of pain, breathlessness, indignity and loss of autonomy, many people prefer to die at home among friends and family, in a dignified way under their own control at a time of their own choosing. Proponents argue for legalization of voluntary euthanasia, with tight controls to ensure consent is freely given and is not distorted by mental illness. Many aspects of advanced medical intervention are widely welcomed. For example, people can now recover from heart attacks and live many more years of productive life. However, hightechnology medicine has created a new phenomenon: the extension of life in a medical environment, often in a hospital or nursing home under constant medical care, with reduced consciousness and a lower quality of life. Whereas people previously would die at home as disease progressed, now their life may be extended through medical interventions. Some, seeing this happen to family or friends and fearing a similar outcome for themselves, see voluntary euthanasia as an alternative, as a way to achieve death with dignity. Anyone desperate to die has plenty of choices, such as jumping from a building, leaping in front of a train, using a gun, or hanging. None of these methods is entirely reliable. People with limited mobility may have difficulty leaping in front of a train or even getting out of a window. All these methods can go wrong and lead to serious injuries, exacerbating the agony from which death is the desired release. Most importantly, these methods are distressing to others, including family, friends and train drivers. They do not fulfill basic criteria for a peaceful death. Death with dignity thus seems to be becoming less common for two convergent reasons: rapidly developing technology to extend life, but under the control of the medical system, and removal of easy, peaceful ways to end one's life.

Religion and Euthanasia

Death is one of the most important things that religions deal with. All faiths offer meaning and explanations for death and dying; all faiths try to find a place for death and dying within human experience. For those left behind when someone dies religions provide rituals to mark death, and ceremonies to remember those who have died. Religions provide understanding and comfort for those who are facing death. Religions regard understanding death and dying as vital to finding meaning in human life. Dying is often seen as an occasion for getting powerful spiritual insights as well as for preparing for whatever afterlife may be to come. Buddhism

Buddhists are not unanimous in their view of euthanasia, and the teachings of the Buddha don't explicitly deal with it.Most Buddhists (like almost everyone else) are against involuntary euthanasia. Their position on voluntary euthanasia is less clear. Buddhism places great stress on non-harm, and on avoiding the ending of life. The reference is to life - any life - so the intentional ending of life seems against Buddhist teaching and voluntary euthanasia should be forbidden. Certain codes of Buddhist monastic law explicitly forbid it. Buddhists regard death as a transition. The deceased person will be reborn to a new life, whose quality will be the result of their karma. Christian

Christians are mostly against euthanasia. The arguments are usually based on the beliefs that life is given by God, and that human beings are made in God's image. Some churches also emphasize the importance of not interfering with the natural process of death.

They believe that:

all life is God-given birth and death are part of the life processes which God has created, so we should respect them

therefore no human being has the authority to take the life of any innocent person, even if that person wants to die

to propose euthanasia for an individual is to judge that the current life of that individual is not worthwhile

such a Judgement is incompatible with recognizing the worth and dignity of the person to be killed

therefore arguments based on the quality of life are completely irrelevant nor should anyone ask for euthanasia for themselves because no-one has the right to value anyone, even themselves, as worthless

Hinduism There are two Hindu views on euthanasia:

By helping to end a painful life a person is performing a good deed and so fulfilling their moral obligations

By helping to end a life, even one filled with suffering, a person is disturbing the timing of the cycle of death and rebirth. This is a bad thing to do, and those involved in the euthanasia will take on the remaining karma of the patient.

The same argument suggests that keeping a person artificially alive on a lifesupport machine would also be a bad thing to do

However, the use of a life-support machine as part of a temporary attempt at healing would not be a bad thing

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Hinduism is less interested than western philosophers in abstract ideas of right or wrong. Rather it focuses on the consequences of our actions. For Hindus, culture and faith are inextricable. So although many moral decisions taken by Hindus seem more influenced by their particular culture than by the ideas of their faith, this distinction may not be as clear as it seems. Islam

Muslims are against euthanasia. They believe that all human life is sacred because it is given by Allah, and that Allah chooses how long each person will live. Human beings should not interfere in this. Euthanasia and suicide are not included among the reasons allowed for killing in Islam. a. Do not take life, which Allah made sacred, other than in the course of justice.--Qur'an 17:33 b. The Prophet said: "Amongst the nations before you there was a man who got a wound, and growing impatient (with its pain), he took a knife and cut his hand with it and the blood did not stop till he died. Allah said, 'My Slave hurried to bring death upon himself so I have forbidden him (to enter) Paradise.' " --Sahih Bukhari 4.56.669

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Alternative solution to Euthanasia

Euthanasia is increasingly being touted as a beguilingly simple solution to the tragedy of a badly managed terminal illness. However, critical examination reveals that, far from being any kind of worthwhile solution, euthanasia turns out to be a Pandoras Box of woes far worse than those which now confront us. It should be emphasized that opposition to euthanasia does not mean that one is committed to maintaining existence to the last possible gasp, nor that one is obligated to apply every available form of life support to those who are clearly dying. Providing therapy aimed at alleviation rather than cure while a disease runs its inevitable course is not the same as willfully ending a life. The intention of such palliative care is not to bring about the death of the patient. Consequently, to call such treatment passive euthanasia is to brandish an oxymoron of the most unhelpful kind. Considering first our duty to persons who are terminally ill, it is of supreme irony that while terminal care has always been a major concern of physicians through the centuries, the explosive triumph of medical knowledge in this generation has served to focus attention in directions that have largely excluded the dying. Such care as is offered means, in the popular mind, a hospice in the form of a gloomy building hidden behind high walls where hushed attendants wait, impotent and silent, until death releases their charges from further pain and suffering. A wide range of pain relieving drugs is available. It is appropriate to begin with well-known mild analgesics such as aspirin or acetaminophen. There are an ever increasing number of other drugs which act in the same way as aspirin. These include indomethacin, ibuprofen, naproxen, and sulindac. They differ in duration of action and side effects, but basically all can provide effective relief of mild-to-moderate pain and are especially effective in providing relief of pain arising from bone and joint. A more potent analgesic is represented by codeine, an opiate derivative. People often unnecessarily fear codeine because of its minimal ability to cause addiction. Its main problem, like all opiates, is that it may cause constipation. Often combined with acetaminophen it is an effective analgesic of moderate strength

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The fear of drug addiction in terminally ill patients would be laughable if it had not caused so many patients to endure needless pain. It is well documented that if morphine is taken for the relief of pain, habituation does not occur. Unless the disease advances, dosage requirements usually remain remarkably stable for many months, and if some other pain relieving procedure is initiated, such as a nerve block, morphine can be quite rapidly withdrawn without provoking the type of severe withdrawal seen in a true addict.

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Impact on Society
All types of euthanasia have an effect on society as well as society has an effect on euthanasia. Should people be given assistance in killing themselves, or should they be forced to suffer the pain and indignity caused by terminal illness. Some members of society feel that by not giving disabled people the ability to end their lives is discrimination. Society may fear that allowing certain individuals help in ending their lives other groups of more vulnerable people will become at risk of feeling pressured into taking that option themselves. Euthanasia could be elected for wrong reason: people see themselves as a burden to society A positive choice has to be made by society in favor of protecting the interests of its vulnerable members even if this means limiting the freedom of others to determine their end

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Cases on Euthanasia
In March 1993 Anthony Bland had lain in persistent vegetative state for three years before a Court Order allowed his degradation and indignity to come to a merciful close. The judges said that if he had made a living will expressing his future wishes he could have been allowed to die in peace earlier. Exit is at the forefront of living will research in the UK. Your subscription will help to make a peaceful death through a living will a reality for anyone who desires it Sue Rodriguez, a mother in her early thirties, died slowly of Lou Gehrig's disease. She lived for several years with the knowledge that her muscles would, one by one, waste away until the day came when, fully conscious, she would choke to death. She begged the Courts to reassure her that a doctor would be allowed to assist her in choosing the moment of death. They refused. She lived on in terror, helped eventually by a doctor who, in February 1994, covertly broke the law to help her die in peace. A law on assisted suicide with rigorous safeguards could have saved her the nightmare during those months before her death, given her the confidence to carry on - with the reassurance that when it got too bad she could rely on a compassionate doctor to follow her wishes at the end. Exit is pledged to support research for drafting the most thorough, yet feasible, assisted suicide Bill yet presented to Parliament. Your support will make it happen. 57 year old Georgette Malette, in the early afternoon of June 30th, 1979, was rushed, unconscious, by ambulance, to hospital. The car in which she was a passenger, driven by her husband, had collided with a truck. Her husband had been killed; she had suffered serious injuries. She was a Jehovah's Witness and carried a card stating her firm conviction that no blood or blood products should be administered to her under any circumstances. The doctor treating her ignored the card and gave her a blood transfusion which he decided was medically indicated. In June 1980 MrsMalette brought charges against Dr Shulman. The judge found that MrsMalette had suffered emotionally and mentally and ordered substantial costs to be paid. It made no difference that the medical team didn't agree with her beliefs. Her advance refusal of treatment was unambiguous. Unfortunately, living wills tend to be far less clear cut, dealing with a wide range of circumstances in which interpretation is sometimes necessary. Exit is at the forefront of research into living wills and other ways of having your wishes respected at the end of life.

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Public support will help us to help make dying more dignified for all those who want to retain some control and self-respect in their dying phase. When her case came to trial, Claire Conroy was unable to move from a semi-fetal position. She was severely demented, had heart disease, hypertension and diabetes and her left leg was gangrenous to the knee; she had sores, couldn't speak, had only a limited ability to swallow, and had eye problems; she had a urinary catheter in place and was unable to control her bowels. She was able to moan and scratch, and occasionally smile when someone combed her hair. Claire Conroy eventually died before the courts were able to decide what to do. She was not a candidate for voluntary euthanasia. She had not made a living will. But her case posed very worrying dilemmas about end of life decisions. Pushing difficult deaths to one side will not make them go away or make them any easier. Exit encourages open discussion of the problems increasingly facing us in society. We care, and we listen with an open mind. We ask you to work with us so that every person can die with dignity in the way that he or she would choose.

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Conclusion
In conclusion, there are still heavy discussions revolving around the topic of euthanasia. Both pro and anti-euthanasia have strong points supporting for and against euthanasia. New Zealand and Netherlands are perfect examples for those points, the two countries are exact opposites in their stand regarding euthanasia and both countries have their own reason. The issue on euthanasia has been debated for years where some countries have legalize it now but other countries are still against the idea of it. Therefore, in my opinion, I believe that euthanasia should be legalized to a certain extent throughout the world to avoid any living being to die from pain and suffering. Technology has played an ever-increasing role in the euthanasia issue. Advances in medical technology have made it more likely that the final stages of life will be both extended and dependent on medical intervention in ways that are, for some, filled with physical and mental suffering. Parallel advances in palliative care have reduced the level of suffering for many, including by slow euthanasia under the supervision of medical professionals. At the same time, technological options for a peaceful death under one's own control are available but restricted by governments opposed to euthanasia.

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Harvard Referencing
Dowbiggin, I. (2005). A concise history of euthanasia: Life, death, God, and medicine.Lanham, MD: Rowman& Littlefield. McInerney, F. (2000)."Requested death": A new social movement. Social Science & Medicine, 50, 137-154. Ogden, R. D. (2001). Non-physician assisted suicide: The technological imperative of the deathing counterculture. Death Studies, 25, 387-401. Syme, R. (2008). A good death: an argument for voluntary euthanasia. Melbourne: Melbourne University Press. Yount, L. (2007). Right to die and euthanasia, 2d ed. New York: Facts on File. Bbc.co.uk (2010) BBC - Ethics: Euthanasia and physician assisted suicide. [online] Available at: http://www.bbc.co.uk/ethics/euthanasia/ [Accessed: 17 Apr 2013]. Bbc.co.uk (2010) BBC - Ethics - Euthanasia: Religion and euthanasia. [online] Available at: http://www.bbc.co.uk/ethics/euthanasia/religion/religion.shtml [Accessed: 17 Apr 2013]. Bbc.co.uk (2010) BBC - Ethics - Euthanasia: Forms of euthanasia. [online] Available at: http://www.bbc.co.uk/ethics/euthanasia/overview/forms.shtml [Accessed: 17 Apr 2013]. Bmartin.cc (2010) Techniques to pass on: technology and euthanasia. [online] Available at: http://www.bmartin.cc/pubs/10bsts.html [Accessed: 17 Apr 2013]. Euthanasia.cc (1996) Euthanasia, right to die: Cases. http://www.euthanasia.cc/cases.html [Accessed: 17 Apr 2013]. [online] Available Available at: at:

Euthanasia.com (n.d.) Euthanasia Pros and Cons. [online] http://www.euthanasia.com/proscons.html [Accessed: 17 Apr 2013].

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